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Celmira Laza Vasquez

 

Health care in rural communities in Colombia. Interview to Celmira Laza Vásquez

Gloria Marlen Aldana de Becerra1
1Centro de Investigación y Desarrollo - CID, Fundación Universitaria del Área Andina, Bogotá, Colombia

Mail delivery: Carrera 2 No. 16A-38 T-2-802. Bogotá, Colombia

Manuscript received by 31.8.2012
Manuscript accepted by 13.12.2012

Index de Enfermería [Index Enferm] 2013; 22(1-2): 98-102

 

 

 

 

 

 

 

How to cite this document

 

 

Aldana de Becerra, Gloria Marlen. Health care in rural communities in Colombia. Interview to Celmira Laza Vásquez. Index de Enfermería [Index Enferm] (digital edition) 2013; 22(1-2). In <https://www.index-f.com/index-enfermeria/v22n1-2/8070e.php> Consulted by

 

 

 

Abstract

 

 

This interview had as its object, counting the experience of the researcher Celmira Laza Vásquez, in a geographic region living the socially and armed conflict in Colombia and discuss the topic of health care in peasant people by the traditional caregivers, from their cultural knowledgement, all of what has contributed to mantain a social movement of pacific resistance experienced in the political field.
Key-words: Community work/ Traditional care/ Cultural knowledge/ Peaceful resistance.

 

 

 

 

 

Introduction

    Celmira Laza Vásquez, professor has a wide experience in Universitary education. She has developed many projects in social investigation, in health of groups, and about the practice of "cultural health care" in rural Colombian communities. The many different awards she has received, like Accesit, first in the Investigation Award III, "Elena EscaneroGella", 2010, tell abouther compromise with investigation on Health Care in no medical systems. Based on theories like the "cultural competency", Laza states the need of rescuing coherence between Nursing interventions and cultural values in communities, as well as the importance of recognizing the cultural context surrounding the Nursing care subject and its cultural health care knowledgement.

Question: Where does your interest comes from on making visible health carein rural rural communities, especially where there is a big presence of the social and armed conflict?
Answer: First, I became next to what was going on, that it remains unknown in the Colombian cities, specifically in Bogotá. What happens in the Colombian rural space? Because, it is important to know how the problem of social and armed conflict is present, in Colombia, which is a country of rural origin as the majority of south cone countries, trying apparent industrialization processes and on the other hand by express solitude from Cimitarra River's Valley Peasant Association (ACVC), on rescuing their collective memoryon how they take care of their health, since their own peasant knowledgement, different from the indigenous knowledgement, because there is no indigenous communities in this zone.
    My interest was to collect and organize the memory of these knowledgement born in the context of the very big social and armed conflict and forced peopledisplacement. In this data compilation some topics as death by aging, traditional peasant medicine transmitted orally in this region, the influence of cities' knowledgement and costumes in the geographic region produced by the different changes becoming actual in the different ambits of society and because of the poor interest of youth to continue traditions not only in health care but in other peasant traditions.
    Other aspect is that in the last time another look to country space has been given in order to retake peasant knowledgement. The social interest has been shifted to alternative paradigms as peasant traditional medicine. There is a movement toward looking for alternatives facing the limitations of biomedical paradigm about health care, not only by the limitations in the scientific field but in the health administration and the difficulties of health systems in assisting all people groups. Mexican anthropologist, Eduardo Menéndez has strongly criticized health assistance biomedical system, because of the scission in relations and social and cultural causes jointed to "health-illness process". Biomedical system is centered in illness and neither in control nor in prevention.
    It is important to take into account, that Scimitars River's Valley population is heterogeneously composed. As a town, it rises in the 50's and 60's, emerging from the forced displacement of people product of political violence. In spite of state abandonment, the big distance from municipal heads, they have survived, without state presence, referred to social policies, investment, sanitary systems, among others.
    It is valid, to retake and systematize these knowledgement, because they are part of this people surviving manifestations. They have a dignified proposal, a pacific resistance proposal, where the traditional peasant health system has been essential to survive. It is a tribute to these people, not only to the traditional health agents, but to a people who has survived, who are a life example, a dignity example. What it is experienced in this place, it is experienced the same in many other places in Colombia, despite it is poor known. There are many zones considered "red zones" (concept of "red zones" in Colombia, is referred to some places with a major presence of the social and armed conflict), where people live in a pacific resistance.

Q.- Is it the traditional peasant health care knowledgement accessible to academic investigators? How much prevention do these communities have facing investigators?
A.- It is complex, referring to logistics. They are communities who have lived under rigor of the social and armed conflict and their life experience oblige them to be mistrustful, if they are not like this, they do not survive. There is no electrical light, no water, there are mosquitoes, all of us who have been there, have suffered malaria. In short, there are too many risks.
It is essential the accompaniment of a community agent to the investigator access the zone; furthermore, the physical access is very hard because of the bad state of roads. In these zones there is a presence of almost all armed irregular groups existing in Colombia: "lefts", "rights" and regular ones as the national army, because it cannot be ignored the case of extra judge executions, the bad named "false positive" (name given to incidents engaged national army members in innocent civil people murder, to make society believe they were dead in combat guerrilla's rebels). Cimitarra's river valley and Catatumbo zone have been some of the most shocked zones by violence, that's why there is always a risk.
    Also, there exists a credibility problem, something complex. But, credibility is gained through time passand constancy. It is necessary to be clear in the investigation objectives, not promising anything beyond limits. My particular experience in this region with peasant people is that a very great overture has been gained in investigative processes. They speak quietly, different from people in displacement situation living in the cities that has been thumbed by investigator without any visible results to communities. Something that surprises me is that they love speaking about their knowledgement on health care.
    One of the big problems of youth is that as there is a lot of influence from cities' costumes, they are not interested in these traditions. Then, the caregivers and healers are charged to transmitting this information. Something interesting is that it has been hard for them to accept the Informed Consent. It is easier for them, to print the digital mark or using a recorded verbal Informed Consent, because of their mistrust to sign any documents.

Q.- How the academic investigators are perceived in this community?
A.- They know what is searched through investigation, the same as the reward that we can give. But it is not so clear for them what it means investigation as a process; maybe, leaders do, because they have received a political education. Although, peasant people has a political education that you cannot imagine! They know that, if different media socialize what is happening in the region, is a gain, and isa benefit for their pacific resistance process. However, it is not a profitable thing; it is not a gambling thing.

Q.- What is the meaning do they give to concepts like health and illness? Is there any difference in women or men about how do they express and live these processes?
A.- The meanings they give to health go beyond a biologic or organic problem. Health is related to balance, to welfare. This balance isrelated to a collective balance; health is a collective construction, it is a balance with nature, basically with welfare.
    According to literature, illness is easy to define because it is felt, it has been lived. However, health is not easy to conceptualize, to categorize. In this community so be set by war, it is hard to define something when it has not been had fully. It is the same with welfare, because it is not just physics but emotional, psychological, beyond body limits. Men and women have a different perception related to heath issue. But, beyond, children, teenagers, old, mothers, perceive in a different way health issues. They expect, some opportunities in health different from what they have lived; they wish their children live in a different way.
    In the instance of Cimitarra's river valley, there are some elements introduced to health and illness concepts. One of them is war. The social and armed conflict, where is evident mental health disorders due to constant problems during too many years. It is too sad that, when you ask an eight year old child, what is it illness for you? He responds: illness is a helicopter, because they bring soldiers and they bring death. Or if a teen ager is asked, hesays, illness is kidnaping, because someone kidnapped is his relative or his friend. Also, it is sad that a an older man tells you that being sick is to be enable to work, "because I am not worthy physically, I am not so agile as some time ago", or a mother or a father with children under five age that tells you that being sick, is that she/he cannot leave home to work because war keeps her off.
    Another element is the way they understand the balance with nature. Nature gives everything necessary to live: water, country, food. But, because of jungle environment, there are some diseases like "malaria" and "dengue". All of these play a role around health - disease issue.

Q.- Who perform health care practice in this community?
A.- Health care is performed by traditional agents who can be classified in two ranges: those who assist disease, the healers, bonesetter and prayers and caregivers. Practices become combined, for instance when a bonesetter fix a bone he also prays because is a part of the treatment but there are some who get specialized more in a practice than in other. Beyond their definition based on what they do, they act thinking that each health alteration in health requires a whole itinerary in healing process.
    For example, something very common in the region is healing snake bite or snake sting (ophitic accident or bite by a poisonous snake) because is a jungle region. To heal snake bites, they use plants that are of knowledgement of the herbal healers. They also pray because the said word is a part of a power given to people by God, so they combine a few different practices. There is another affaire, and this is the midwife, who is not a healer, cause pregnancy is not assumed like a disease but a part of life, then the midwife is not a healer but she takes care of life,she contributes to life's blossom in the best conditions.

Q.- How do care givers are educated?
A.- Education of traditional agents, those who heal illness, is acquired through a divine call. They feel that they have some kind of power granted to perform their activity, more than a power; they feel they are instruments of a divine force, this is catholic collective. Knowledge is learned, from whom you can learn, but if you are not elected, this is bootless. That is why that tuition is not paid or it is paid with some kind of service. For instance, you live with the person who teaches you, you work free for him and in that process some relation of friendship is established or many times the instruction is made from the mother to her daughter, from the grandmother to the granddaughter, it's an interchange in knowledge.
    Referring to midwives, there is also a knowledge interchange, a midwife talks to another and their knowledgement is interchanged. Midwives do not emerge trough a divine call. They are made by necessity to help other women to give birth, many women learn because they had to help her daughter in giving birth. Others learned looking others "helping in labor and bearing", it is learned in family or with other midwives but it does not mean the midwife had to live with the bearing woman. To help women in bearing is essential to have given birth, because a great part of their learning is obtained from the knowledge of their own delivery. Many midwives express they would like to study medicine or nursing.

Q.- When healers initiate ¿do they have any accompaniment from other similar?
A.- Initially yes, specially men have accompaniment. This is another point; healers are men in a great majority. There is evident, a form of work social division, man heals and woman takes care, this coincides a little with nursing origins. Also, it is assumed that "help in bearing" is easier than healing, because healing implies many elements, because it covers more health alterations.

Q.- Endemic diseases are identificated in that region?
A.- Diseases are not known at all, but they are relational with region characteristics, jungle environment, alterations are seen like tropical diseases; also, muscle, bone or fractures alterations. Something that is present is almost all peasant regions are diseases of cultural filiation, it means alterations explained in their own context, the famous 'evil eye', dead cold or 'descuajadura' (no translating found, similar to an uncurdling process, a rennet breaking process).
    Idoyaga Molina, an Argentine, who has investigated these traditional peasant practices, says that this it is hard to understand, especially to people with health education. In peasant contexts, health alterations, health practices and traditional agents cannot be classificated like in the biomedical system classification. Medical systems have two parts: one, the epistemological one, which is as all knowledge, is known, relational to life's concept and the second one, the health practices where a healed individual-healer relation is established. In traditional peasant systems, these two aspects are much related and they are understood in a quite different way from the way they are understood in the biomedical system.

Q.- Do people of this region mix practices of biomedical medicine with traditional peasant medicine in their health care?
A.- Yes, it is necessary to recognize that traditional peasant medicine have limits, for example, in the subject of some midwives, Cruz Roja has taught some short courses; when it is malaria time, health's promoter distributes treatment drugs and gives sanitary education. Many times, midwives mix their traditional practices with biomedical ones, for example, alcohol is used like an antiseptic and like an antibacterial; they wash their hands with alcohol, this is considered as a hot substance. One thing is racing with alcohol is iodine solution which is applied everywhere. Pregnancy and delivery is a matter of unbalance for them. In delivery, there is a lot of flowing hot liquids; placenta, newborn, blood, which are hot, then woman remains cold. This concept rules the whole care process. If some things are had at hand's reach that help counteracting cold, lemon, hot water, brown sugar, "panela" (sugar cane), there are used. When there are bullet or bowie knife wounds some antibiotic or antitetetanus vaccine are administered. When delivery is deleted, this vaccine is administered to avoid infection.
    This way biomedical speeches become mixed with peasant practices, what it points out there is no pure health practices.

Q.- What is the worthiest thing to know in health care in the traditional peasant medicine?
A.- The valuable thing is seen in two ways: One, that this is a plus knowledge and other, that it is part of the immaterial legacy of Colombia, of a multicultural Colombia, rich in indigenous knowledge and peasant one. This is part of what we are, of our origins that cannot be denied. Unfortunately, many times this knowledge has been denied, it has been made invisible until making it ridiculous.
    In the instance of these communities who have lived the armed conflict, who have been abandoned by the State and they continue in abandonment, who scarcely read and write but who have resisted the most impossible thing to imagine, since malaria until economic blocking, who have lived in a pacific resistance, with an unbelievable dignity, this knowledge have helped them to survive. People share how to cook a monkey bouillon to healing malaria, how to pray a snake chopping. This knowledge has helped people to survive, no matter it is not a scientific knowledge it has the most value. For example, a midwife could be an analphabet and maybe her practices can be unadecuated but the great majority of children survive and they become born inside an unbelievable love and affection.

Q.- Does this community have access to Colombian health system?
A.- No, because the state abandonment is huge.

Q.- What does imply to traditional peasant health care knowledge, the investigation results diffusion in congress and other scientific media? What kind of risks could come on?
A.- On the one hand, it contributes to make the situation more visible in the region. They already have other mechanisms to make them visible, but now is to do it in a medium where they had no access like the academic one. The movement has not already gained strength in the academic medium, although there are several people researching, Professor Daniel Eslava, professor Maria Nubia Romero who have worked in these topics. Some anthropologists have focused more in indigenous communities than in peasant ones but I think the investigative rhythm should be maintained to continue contributing to this subject matter comprehension.
    A dialog between the professional and not professional thing could be considered, furthermore the intercultural thing. It is to think in that dialog in order to have the "other's look" in present. From the nursing discipline, it is in sight, for instance, how the woman's voice who is in labor at a hospital has a presence and a power. It has been demostrated in some studies that the possibility a woman has accompaniment and familiar support during the her delivery attention has a great influence in its course.
    It is utopic to think in avoiding shocks between peasant knowledge, that has a belief system, which was born inside it, which has lived inside it, and the knowledge of the health professional. These shocks could be addressed from Madeleine Leininger's sight, with the position of the cultural competence where the first step is the knowledgement, with which the delivery process could be achieved in a better way, for example, nursing care would be more benficious and effective. But this, only could be achieved if there is a dialog that allows an interchange and approach.

Q.- Investigation results diffusion could put in a risk a knowledge that in general is orally transmitted?
A.- Investigation is not only showing.
    There is an interest, what I am going to make with the obtained knowledge, which is my interest in this, it is necessary to look how it maybe used, how you handle it and why do I want the information, how am I going to use the information, to construct or to destroy?
    Wealth could belost if knowledge is not maintained in an oral way; that knowledge can be systematized, but its protection depends on how the information is used, on how itis published. If a respect agreement is made with the participants, that knowledge is preserved.

Q.- Is it possible that traditional peasant knowledge feedback curricula of health academic programs?
A.- Meanwhile public politic, sanitary systems and actual health systems don't look at "other" curricula neither will do it. Specifically, in nursing discipline and in other areas of health, epistemological shocks and politic interest are very strong.

 

 

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